Tissue factor (TF) is the cellular receptor for plasma protease factor VIIa (FVIIa), and the TF-FVIIa complex initiates coagulation in both hemostasis and thrombosis. Cell surface-exposed TF is mainly cryptic and requires activation to fully exhibit the procoagulant potential. Recently, the protein disulfide isomerase (PDI) has been hypothesized to regulate TF decryption through the redox switch of an exposed disulfide in TF extracellular domain. In this study, we analyzed PDI contribution to coagulation using an in vitro endothelial cell model. In this model, extracellular PDI is detected by imaging and flow cytometry. Inhibition of cell surface PDI induces a marked increase in TF procoagulant function, whereas exogenous addition of PDI inhibits TF decryption. The coagulant effects of PDI inhibition were sensitive to annexin V treatment, suggesting exposure of phosphatidylserine (PS), which was confirmed by prothrombinase assays and direct labeling.In contrast, exogenous PDI addition enhanced PS internalization. Analysis of fluorescent PS revealed that PDI affects both the apparent flippase and floppase activities on endothelial cells. In conclusion, we identified a new mechanism for PDI contribution to coagulation on endothelial cells, namely, the regulation of PS exposure, where PDI acts as a negative regulator of coagulation. (Blood. 2010; 116(6):993-1001)
IntroductionTissue factor (TF) is a transmembrane glycoprotein that binds with high affinity to the plasma protease factor VII in either zymogen (FVII) or activated form (FVIIa). The formation of the TF-FVIIa complex is crucial for initiation of coagulation, leading to thrombin generation and fibrin formation. Although the primary role of TF-FVIIa is to maintain hemostasis after vascular injury, aberrant activation of coagulation underlies thrombosis, the major cause of mortality in most industrialized countries. 1 In physiologic conditions, initiation of coagulation is maintained silent by restricting the exposure of TF to the plasma factors. 2,3 In pathologic conditions, however, TF may become exposed on the endothelium 4,5 and on circulating monocytes. 6 At these sites, TF can initiate thrombotic events associated with sepsis, 4,7 cancer, 8,9 or atherosclerosis. 10,11 Multiple in vitro studies have indicated that most of the cell-exposed TF is "cryptic," thus not fully active toward coagulation, 12,13 and TF "decryption" has been proposed as the initial step in the activation of coagulation. 14 Although the molecular mechanisms of TF decryption are not completely understood, many of the stimuli that decrypt TF also increase the exposure of phosphatidylserine (PS), [15][16][17][18] which is known to enhance coagulation. PS-independent mechanisms of TF decryption have also been postulated, such as TF self-association, 19 association with lipid rafts, [20][21][22] and the redox switch of an exposed disulfide in the membrane proximal domain of TF. 23 Protein disulfide isomerase (PDI) is an oxidoreductase 24 localized mainly in the endoplasmic reticulum (ER...