Type 1 plasminogen activator inhibitor (PAI-1), the primary inhibitor of tissue-type plasminogen activator (t-PA), circulates as a complex with the abundant plasma glycoprotein, vitronectin. This interaction stabilizes the inhibitor in its active conformation In this report, the effects of vitronectin on the interactions of PAI-1 with fibrin clots were studied. Confocal microscopic imaging of platelet-poor plasma clots reveals that essentially all fibrin-associated PAI-1 colocalizes with fibrin-bound vitronectin. Moreover, formation of platelet-poor plasma clots in the presence of polyclonal antibodies specific for vitronectin attenuated the inhibitory effects of PAI-1 on t-PA-mediated fibrinolysis. Addition of vitronectin during clot formation markedly potentiates PAI-1-mediated inhibition of lysis of 125 I-labeled fibrin clots by t-PA. This effect is dependent on direct binding interactions of vitronectin with fibrin. There is no significant effect of fibrin-associated vitronectin on fibrinolysis in the absence of PAI-1. The binding of PAI-1 to fibrin clots formed in the absence of vitronectin was characterized by a low affinity (K d ϳ 3.5 M) and rapid loss of PAI-1 inhibitory activity over time. In contrast, a high affinity and stabilization of PAI-1 activity characterized the cooperative binding of PAI-1 to fibrin formed in the presence of vitronectin. These findings indicate that plasma PAI-1⅐vitronectin complexes can be localized to the surface of fibrin clots; by this localization, they may modulate fibrinolysis and clot reorganization.Tissue-type plasminogen activator (t-PA) 1 initiates intravascular fibrinolysis by binding to fibrin, where it activates fibrinbound plasminogen (1-4). The major inhibitor of t-PA, type 1 plasminogen activator inhibitor (PAI-1), circulates in plasma and is released from platelet ␣-granules during blood clotting (5, 6). PAI-1 accumulates in thrombi, rendering them resistant to t-PA-mediated fibrinolysis (7-14). In purified systems, PAI-1 has been shown to bind directly to fibrin, with a K d of 3.7 M (15-18). Consequently, it has been hypothesized that PAI-1 accumulation in thrombi reflects a direct interaction of PAI-1 with fibrin. PAI-1 circulates in plasma (19,20) and platelets in complex with vitronectin (21, 22, 23, 24), a glycoprotein that binds PAI-1 with high affinity (25). The vitronectin interaction with PAI-1 stabilizes the inhibitor in its active conformation (26, 27), induces allosteric changes in vitronectin that expose cryptic epitopes (28, 29), and modulates vitronectin-dependent cell adhesion (25,30,31). Domain mapping studies using proteolysis, synthetic peptides, monoclonal antibodies, and site-directed mutagenesis have identified two discrete sites on vitronectin that may bind and stabilize 33,34). Similar approaches have delineated a single vitronectin-binding site on PAI-1 (35, 36).Recent studies from our laboratories have further characterized the PAI-1-vitronectin interaction. Analytical ultracentrifugation experiments indicate that PAI-1 and native vi...