Local abnormalities of coagulation and fibrinolysis and alveolar fibrin deposition in sheep with oleic acid-induced lung injury.

Extravascular, primarily intra-alveolar, fibrin deposition is a histologic hallmark of acute lung injury in humans and experimental animals, but the mechanisms leading to this finding are poorly understood. To determine whether local abnormalities in the fibrinolytic-procoagulant balance contribute to alveolar fibrin deposition in acute lung injury, we studied bronchoalveolar lavage (BAL) fluids of anesthetized sheep that received intravenous oleic acid. Prominent alveolar fibrin deposition was observed within 2 h after oleic acid-induced lung injury. Procoagulant and fibrinolytic activities were determined in BAL samples of anesthetized, mechanically ventilated sheep before and 2 h after intravenous oleic acid or saline. BAL procoagulant activity was found to be due mainly to tissue factor associated with Factor VII. In baseline BAL samples, we found relatively low levels of procoagulant activity and relatively high levels of fibrinolytic activity. After induction of oleic acid-induced lung injury, the procoagulant activity of BAL was markedly increased, whereas fibrinolytic activity was either depressed or undetectable. Antiplasmin activity was detectable in BAL of sheep after oleic acid-induced lung injury, which contributed at least in part to the depressed fibrinolytic activity observed. These perturbations occurred with the appearance of extensive alveolar fibrin deposition. In control sheep, BAL fibrinolytic activity was decreased, and antiplasmin activity increased modestly after 2 h of mechanical ventilation, but procoagulant activity was unchanged and alveolar fibrin was not observed. Procoagulant activity in lung lymph and plasma after lung injury did not differ from baseline values, and fibrinolytic activity was undetectable in lymph or plasma samples. These data indicate that increased procoagulant activity and concurrent disruption of the balance of coagulation and fibrinolysis establish local conditions that promote acute fibrin deposition in the alveoli of mechanically ventilated, oleic acid-injured sheep.

An inhibitor of plasminogen activator in rabbit endothelial cells.

The antifibrinolytic activity of cytosols obtained from cultured rabbit endothelial cells was studied to determine whether it resulted from the presence of an antiplasmin or an antiactivator. These cytosol preparations inhibited the fibrinolytic activity initiated by some plasminogen activators (e.g. urokinase, rabbit endothelial cell activator), but not others (e.g. activators associated with bovine endothelial cells and Rous sarcoma virus-infected chick embryo fibroblasts), suggesting that inhibition occurred at the level of plasmin formation, not plasmin activity. The fibrinolytic activity of plasmin itself was unaffected by concentrations of cytosol that completely blocked urokinase-mediated fibrinolysis consistent with this conclusion. In addition, the ability of urokinase to cleave 125I-plasminogen into its characteristic activation fragments was inhibited by cytosol in a dose-dependent manner. When urokinase was analyzed by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, two peaks of activity were detected, corresponding to Mr = 55,000 and 32,000. Urokinase preincubated with cytosol and analyzed in a similar manner demonstrated no activity in any portion of the gel, suggesting that its ability to function as a plasminogen activator was irreversibly lost following its interaction with cytosol. These results indicate that the antifibrinolytic activity of rabbit endothelial cells results from the presence of a molecule or molecules with antiactivator activity. The cellular location and unusual degree of specificity distinguish the endothelial cell inhibitor(s) from antifibrinolytic agents observed in other cells and in plasma and platelets.