Fibrinolytic system of vascular endothelial cells. Role of plasminogen activator inhibitors.

The regulation of the fibrinolytic system is of critical importance during hemostasis, wound repair, neoplasia, inflammation, and a variety of other biologic processes. This control is achieved in a large part through the action of specific plasminogen activator inhibitors (PAIs). Cultured endothelial cells (ECs) produce type 1 PAI (PAI-1), the physiologic inhibitor of tissue-type plasminogen activator. PAI-1 is one of the most highly regulated of the fibrinolytic components produced by ECs. Its synthesis is modulated by a variety of compounds including endotoxin, thrombin, transforming growth factor beta interleukin 1, and tumor necrosis factor alpha. Recent studies suggest that PAI-1 is synthesized by ECs as an active molecule, but that it spontaneously decays into a latent form in solution. Specific components present in the extracellular matrix of ECs and in plasma bind to PAI-1 and prevent this inactivation. The unexpected finding that cultured ECs also produce type 2 PAI (PAI-2) introduces a previously unsuspected level of complexity to our understanding of this system and raises the possibility that the altered fibrinolytic activity of ECs following various treatments, or of blood in certain individuals, may reflect changes in either one of these inhibitors.