Abstract-Coagulation and fibrinolysis are processes that form and dissolve fibrin, respectively. These processes are exquisitely regulated and protect the organism from excessive blood loss or excessive fibrin deposition. Regulation of these cascades is accomplished by a variety of mechanisms involving cellular responses, flow, and protein-protein interactions. With respect to regulation mediated by protein-protein interaction, the coagulation cascade appears to be more complex than the fibrinolytic cascade because it has more components. Yet each cascade is regulated by initiators, cofactors, feedback reactions, and inhibitors. Coagulation is also controlled by an anticoagulant pathway composed of (minimally) thrombin, thrombomodulin, and protein C. 1 Protein C is converted by the thrombin/thrombomodulin complex to activated protein C (APC), which catalyzes the proteolytic inactivation of the essential cofactors required for thrombin formation, factors Va and VIIIa. An analogous antifibrinolytic pathway has been identified recently. This pathway provides an apparent symmetry between coagulation and fibrinolysis and is also composed of thrombin, thrombomodulin, and a zymogen that is activated to an enzyme. The enzyme proteolytically inactivates a cofactor to attenuate fibrinolysis. However, unlike APC, which is a serine protease, the antifibrinolytic enzyme is a metalloprotease that exhibits carboxypeptidase B-like activity. Within a few years of each other, 5 groups independently described a molecule that accounts for this antifibrinolytic activity. We refer to this molecule as thrombin activatable fibrinolysis inhibitor (TAFI), a name that is based on functional properties by which it was identified, assayed, and purified.(Because of the preferences of some journals "activatable" is occasionally referred to as "activable.") This review will encompass a historical account of efforts to isolate TAFI and characterize it with respect to its activation, activity, regulation, and potential function in vivo.
Discovery of TAFIOur initial efforts were directed toward understanding the apparent profibrinolytic effect of the anticoagulant APC, which had been reported previously. 2,3 In the work of Taylor and Lockhart, 2 the modest acceleration of fibrinolysis evoked by APC in a cell-free system was more pronounced in clots formed from either whole blood or platelet-poor plasma supplemented with leukocytes. Other investigators showed that APC can consume plasminogen activator inhibitor-1 (PAI-1), thereby sparing tissue plasminogen activator (tPA), and this was offered as an explanation for the apparent profibrinolytic properties of APC. 4 -6 Consumption of PAI-1 by APC, however, is a kinetically unfavorable reaction when it is compared with inhibition of tPA by PAI-1. 7 Alternative explanations included APC inhibition of thrombin production, which would otherwise inhibit fibrinolysis either by the stimulation of PAI-1 release from platelets 8 or by some unknown mechanism. 9 We investigated the profibrinolytic effect of A...