Tissue factor (TF) initiates the extrinsic coagulation cascade and is a high-affinity receptor for coagulation factor VII. TF also participates in protease-activated receptor (PAR)1 and PAR2 activation. Human epithelial basal cells were previously purified on the basis of TF expression. The purpose of this study was to determine if tracheobronchial epithelial basal cell-associated TF drives coagulation and/ or activates PARs to promote basal cell functions. We used human tracheobronchial tissues to isolate human airway epithelial cells using specific cell surface markers by flow cytometry and studied TF expression by immunostaining. TF-dependent fibrin network formation was observed by confocal and scanning electron microscopy. TF knockdown was done using short hairpin RNA, and TF mRNA was measured using quantitative RT-PCR. We found that 97 6 5% of firstpassage human tracheobronchial epithelial cells were basal cells, and 100% of these basal cells expressed TF. Basal cell-associated TF was active, but TF activity was dependent on added extrinsic coagulation cascade factors. TF inhibition caused basal cell apoptosis and necrosis. This was due to two parallel but interdependent TFregulated processes: failure to generate a basal cell-associated fibrin network and suboptimal PAR1 and PAR2 activity. The data indicate that membrane surface TF mediates airway epithelial basal cell attachment, which maintains cell survival and mitotic potential. The implications of these findings are discussed in the context of basal cell-associated TF activity in normal and injured tissues and of the potential for repair of airway epithelium in lung disease.Keywords: tissue factor; epithelium; clotting; fibrin; tracheobronchial Tissue factor (TF) is a transmembrane cell receptor and cofactor for factor VII (FVII) and serves biological functions beyond its established role in blood coagulation (1). TF may act as a transmembrane signaling molecule by activating and delivering coagulation factors for signaling, and the TF-coagulation FVIIa complex activates G protein-coupled receptors, including the protease-activated receptors (PARs) (2). Under pathologic conditions, TF can be expressed by circulating blood elements (monocytes, neutrophils, and platelets) and by an associated elevated number of cell-derived circulating microparticles. The role of TF in epithelial cell function is much less well understood than its role in the circulation and in hemostasis.In acute lung injury, increased coagulation and decreased fibrinolysis result in diffuse alveolar fibrin deposition, potentially increasing lung inflammation (3). Recent evidence indicates that the damaged alveolar epithelium expresses TF (4) and that FVII-activating protein expression is increased (5). Alveolar procoagulant microparticles are also elevated (6), and intrinsic elevation of tissue factor pathway inhibitor (TFPI) expression is insufficient to inhibit this procoagulant effect (7). Coagulation pathologies also occur in conducting airways. For example, the sulfur mustard ana...