Recent studies suggest a crucial role for plasminogen activator inhibitor-1 (PAI-1) in mediating stress-induced hypercoagulability and thrombosis. However, the mechanisms by which PAI-1 is released by stress are not well-delineated. Here, we examined catecholaminergic neurosecretory cells for expression, trafficking, and release of PAI-1. PAI-1 was prominently expressed in PC12 pheochromocytoma cells and bovine adrenomedullary
IntroductionPlasminogen activator inhibitor type 1 (PAI-1) is a member of the serine protease inhibitor (SERPIN) superfamily. Its major recognized function is regulation of the fibrinolytic system by rapidly inhibiting the plasminogen activators tissue plasminogen activator (tPA) and urokinase (uPA), thus preventing activation of plasminogen to plasmin. 1 Elevated plasma concentrations of PAI-1 have been observed in a variety of thrombotic disorders, including deep vein thrombosis, 2 myocardial infarction, [3][4][5] and disseminated intravascular coagulation. 6 Recent studies have suggested an important association and role for the stress response in promoting thrombotic events. Mental and physical stress substantially decrease fibrinolytic activity. 7 Acute stress and chronic stress are associated with elevated plasma concentrations of PAI-1 antigen in humans and in rodent models. 8,9 Chronic stress is associated with elevated plasma PAI-1 antigen concentrations in middle-aged men. 8 Studies using a restraint stress paradigm in mice demonstrated a striking increase in plasma PAI-1 antigen concentrations in response to acute stress. 9 In addition, the PAI-1 response correlated with tissue thrombosis, particularly in older stressed mice. 9 Moreover, much less tissue thrombosis was induced by restraint stress in both young and aged PAI-1 deficient mice compared with age-matched wildtype mice. 9 These results demonstrate that increased expression and release of PAI-1 in response to physiologic and pathologic stress increase the prothrombotic potential, thus promoting thrombotic complications under stressful conditions. Hence, these results suggest a crucial role for PAI-1 in mediating stress-induced hypercoagulability and thrombosis. However, the mechanisms by which PAI-1 plasma concentrations are increased by stress are not well delineated. Of note, the stress response is characterized by, and in large part mediated by, activation of the sympathoadrenal system causing exocytotic release of amines and proteins from catecholamine storages vesicles of the adrenal medulla and sympathetic neurons. 10 Interestingly, in the above mentioned murine studies, restraint stress was associated with a pronounced increase in PAI-1 mRNA expression in the adrenal medulla. 9 However, the intracellular trafficking of PAI-1 and its release from these cells (ie, via regulated versus constitutive secretory pathways 11,12 ) are fundamental issues that have not been elucidated. Therefore, we tested the hypothesis that PAI-1 is targeted to and released directly by exocytosis from adrenomedullary catecholamine storag...