The alveolar epithelium can initiate the extrinsic coagulation cascade through expression of tissue factor
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BACKGROUND: The alveolar compartment is a procoagulant antifibrinolytic environment in acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). A study was undertaken to test the hypothesis that the alveolar epithelium can initiate intra-alveolar coagulation by expressing active tissue factor (TF). METHODS: Using an in vitro cell surface TF assay and TF ELISA, the activity and production of TF in cultured alveolar epithelial (A549) cells following exposure to cytomix (tumour necrosis factor alpha, interleukin 1beta and interferon gamma) was measured. TF gene transcription was measured by semi-quantitative reverse-transcription PCR. Immunohistochemistry for TF was performed on lung sections from patients with ARDS and controls. TF protein levels were measured by ELISA in undiluted pulmonary oedema fluid from patients with ALI/ARDS and compared with control patients with hydrostatic pulmonary oedema. RESULTS: TF activity, mRNA and protein levels increased in A549 cells after stimulation with cytomix. Increased TF activity was also seen in A549 cells following incubation with pulmonary oedema fluid from patients with ALI/ARDS. Immunohistochemistry for TF in human lung tissue from patients with ARDS showed prominent TF staining in alveolar epithelial cells as well as intra-alveolar macrophages and hyaline membranes. TF antigen levels in oedema fluid (median 37 113 (IQR 14 956-73 525) pg/ml) were significantly higher than in plasma (median 336 (IQR 165-669) pg/ml, p<0.001) in patients with ALI/ARDS, and TF procoagulant activity in oedema fluid was much higher than in plasma of these patients. Higher plasma levels were associated with mortality. CONCLUSIONS: The alveolar epithelium is capable of modulating intra-alveolar coagulation through upregulation of TF following exposure to inflammatory stimuli and may contribute to intra-alveolar fibrin deposition in ARDS.
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Intra-alveolar neutrophils and injured alveolar epithelial cells are key producers of tissue factor, which directly stimulates fibrin deposition in alveolar spaces, hyaline membranes, and fibrotic foci.
“Intra-alveolar neutrophils and injured alveolar epithelial cells are also key producers of tissue factor, which directly stimulates fibrin deposition in alveolar spaces, hyaline membranes, and fibrotic foci (47, 48).”
From Lung epithelial and endothelial damage, loss of tissue repair, inhibition of fibrinolysis, and cellular senescence in fatal COVID-19 (2021) · cites this paper as [47]
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- Authors
- Bastarache, J. A., Wang, L., Geiser, T., Wang, Z., Albertine, K. H., Matthay, M. A., & Ware, L. B.
- Affiliations
- Vanderbilt University (US)
- University of Bern (CH)
- University of Utah (US)
- University of California, San Francisco (US)
- Corresponding author
- Bastarache, J. A
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2007-02-27
- Volume
- 62
- Issue
- 7
- Pages
- 608-616
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC2117249
- OpenAlex
- W2137035430
- Cited by
- 148
- References
- 43
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 1 · 2022: 6 · 2021: 10 · 2020: 16 · 2019: 4 · 2018: 4 · 2017: 9 · 2016: 10 · 2015: 8 · 2014: 6 · 2013: 7 · 2012: 14
- FWCI
- 6.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- University of California, San Francisco
- National Heart, Lung, and Blood Institute (HL-51856, HL-081332, R01HL051856, HL-70521, HL 74005, P50HL074005, U01HL081332, K08HL070521, R37HL051856)
- Topics
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Keywords
- tissue factor, alveolar epithelium, extrinsic coagulation pathway, acute lung injury, acute respiratory distress syndrome, A549 cells, inflammatory cytokines, hyaline membranes
- MeSH terms
- Blood Coagulation, Cells, Cultured, Enzyme-Linked Immunosorbent Assay, Female, Fibrin, Humans, Immunohistochemistry, Male, Pulmonary Alveoli, Pulmonary Edema, RNA, Messenger, Thromboplastin, Gene Expression, Polymerase Chain Reaction, Respiratory Mucosa
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