Whole blood clot lysis: in vitro modulation by activated protein C

Lysis of clots prepared from native or citrated whole blood as measured by release of 125I fibrinogen degradation products was 10% or less at 20 hours. Lysis of these clots was accelerated by activated protein C in a dose-dependent manner (0.1 to 20 micrograms/ml) from less than 10% to 60-80% at 20 hours. Lysis of clots prepared from native or citrated platelet poor plasma across the same concentration range of activated protein C was less than 15%. Gla-domain-less activated protein C was equally effective in accelerating clot lysis whereas DIP-activated protein C or factor Xa did not accelerate clot lysis. This suggested that this action of activated protein C was enzymatic and this this action was limited to protein C among the vitamin K dependent proteins. The unresponsiveness of platelet poor plasma to activated protein C was completely restored to that of whole blood by addition of mononuclear leukocytes. Addition of red corpuscles or platelets alone had no effect on this response, while addition of polymorphonuclear leukocytes partially restored this response. Addition of metabolic inhibitors 2-deoxyglucose and oligomycin inhibited the response of whole blood and of plasma-mononuclear leukocytes to activated protein C. Reconstitution studies of platelet poor plasma made deficient in plasminogen activator and plasminogen showed that accelerated clot lysis produced by mononuclear leukocytes and activated protein C required the presence of plasminogen. We concluded, therefore, that activated protein C accelerates whole blood or plasma-leukocyte clot lysis by modulating activation of the plasminogen system by metabolically active leukocytes.