native C-terminus that directs the attachment of a glycosylphosphatidylinositol (GPI) anchor, but whether TFPI protein is actually expressed is not clear. Moreover, previous studies have suggested that the predominant form of TFPI released from cells by phosphatidylinositolspecific phospholipase C (PIPLC) treatment is TFPI␣, implying it is bound at cell surfaces to a separate GPI-anchored coreceptor. Our studies show that the form of TFPI released by PIPLC treatment of cultured endothelial cells and placental microsomes is actually TFPI based on (1) migration on SDS-PAGE before and after deglycosylation, (2) the lack of a Kunitz-3 domain, and (
IntroductionTissue factor pathway inhibitor (TFPI) is the key endogenous regulator of TF-initiated coagulation. TFPI inhibits factor Xa (FXa) directly, and, in a FXa-dependent manner, inhibits factor VIIa/tissue factor (FVIIa/ TF) activity. 1 The human TFPI gene encodes for 2 dominant messages that are generated by alternative intron/exon splicing (GenBank NM_006287.4, GenBank NM_001032281.2). TFPI␣, the originally described message, encodes a signal peptide that is removed by processing, followed by a 276-amino acid protein that consists of an acidic N-terminal region, 3 tandem Kunitz-type protease inhibitor domains, and a basic C-terminal region. 2 Functional studies reveal that the Kunitz-2 domain mediates binding to and inhibition of FXa, whereas the Kunitz-1 domain is responsible for recognition and inhibition of the TF/FVIIa complex. 3 The Kunitz-3 domain lacks protease inhibitor activity; however, it and the C-terminal basic region of TFPI␣ are required for protein S enhancement of inhibition of FXa. 4,5 The TFPI message lacks the Kunitz-3 and C-terminal exons of TFPI␣, and in their place is an exon that encodes a 42-amino acid C-terminal sequence following residue 181 of TFPI␣. This new C-terminal sequence is predicted to direct the proteolytic cleavage of the peptide following N193 with the attachment of a GPI anchor. The protein mass of TFPI is less than that of TFPI␣, but it migrates on SDS-PAGE at a molecular weight similar to TFPI␣ (46 kDa) apparently because of greater sialylation of its O-linked carbohydrate. 6 In humans, TFPI circulates in plasma at approximately 70 ng/mL (1.6nM), with 80% being a C-terminal truncated form that is lipoprotein associated and the remaining 20% being full-length and near full-length TFPI␣ forms. 7,8 Platelets contain TFPI␣ and, at the site of injury TFPI␣ levels, increase dramatically. 9,10 The parenteral administration of heparin to humans increases the circulating levels of total TFPI in plasma to approximately 2.5-fold baseline levels. 11,12 The form of TFPI that is released is full-length TFPI␣. 13 Heparin also increases the release of TFPI from endothelial cells in culture, 6,14 even though treatment with heparin does not perceptibly reduce surface TFPI. 6,15,16 The endothelium appears to be the major source of TFPI in vivo. In human endothelial cell cultures, the ratio of TFPI␣/TFPI mRNA varies between 5 and 10. 1...