Hemostatic abnormalities associated with obesity and the metabolic syndrome
Article first published online: 29 APR 2005
Journal of Thrombosis and Haemostasis
Volume 3, Issue 5, pages 1082–1083, May 2005
How to Cite
JUHAN-VAGUE, I. and ALESSI, M. C. (2005), Hemostatic abnormalities associated with obesity and the metabolic syndrome. Journal of Thrombosis and Haemostasis, 3: 1082–1083. doi: 10.1111/j.1538-7836.2005.01281.x
- Issue published online: 29 APR 2005
- Article first published online: 29 APR 2005
Role of fibrinolytic and anti-fibrinolytic agents
Increased circulating levels of plasminogen activator inhibitor (PAI)-1 are associated with the metabolic syndrome and may contribute to the increased cardiovascular risk that characterizes this syndrome. Indeed, the main function of PAI-1 is to promote fibrin accumulation. However, PAI-1 is also involved in cell migration and adhesion, and in angiogenesis and fibrosis. This means PAI-1 is central to tissue remodeling, especially in atherosclerotic vessel walls and adipose tissue. PAI-1 is produced from adipose tissue, especially visceral fat. In addition, overproduction of PAI-1 has been found from the steatotic liver of obese individuals. PAI-1 is an acute-phase protein and a variety of data argue for a local coregulation of PAI-1 expression by the inflammatory environment (mainly tumor necrosis factor and transforming growth factor-β) and by the hormones insulin and cortisol [1,2]. Recent results suggest that increased oxidative stress in accumulated fat dysregulates production of several adipocytokines, among them PAI-1 .
It appears that PAI-1 may contribute to the development of obesity and the metabolic syndrome. An interaction of PAI-1 with the insulin response has been shown in vitro. Vitronectin, an abundant adhesive glycoprotein in plasma and extracellular matrix, binds PAI-1 and controls its activity by stabilizing PAI-1 in the active form. The binding of vitronectin to its receptor, integrin αvβ3, potentiates insulin's action by increasing expression of insulin receptor substrate (IRS-1) and phosphorylation of protein kinase B. The addition of PAI-1 reverses this effect and therefore inhibits transmission of the insulin signal .
In vivo evidence of a direct role of PAI-1 in obesity and insulin resistance has been provided in mice. Disruption of the PAI-1 gene in genetically obese ob/ob mice reduces adiposity and improves the metabolic profile . The development of obesity and insulin resistance in wild-type mice on a high-fat diet was completely prevented in those mice lacking PAI-1. PAI-1 deficiency also enhanced basal and insulin-stimulated glucose uptake in adipose cells in vitro. Interestingly, we found that transgenic mice overexpressing murine PAI-1 within adipose tissue and kept on a high-fat diet developed subcutaneous adipocyte hypotrophy with increased expression of preadipocyte factor-1, which blocks adipocyte differentiation . Aged transgenic mice also present lower body weight and higher fasting insulin levels than wild type mice . In vitro, active PAI-1 was able to inhibit preadipocyte attachment to vitronectin . These results suggest that high levels of circulating and adipose tissue PAI-1 are able to modify the development of adipose tissue and insulin resistance. Recent data show that a pharmacological inhibitor of PAI-1 given to aged mice is associated with a small improvement in metabolic parameters . This suggests that in vivo inhibition of PAI-1 could exert a beneficial effect.
Some clinical data also support a direct contribution of PAI-1 to the development of obesity and the metabolic syndrome. The prospective study IRAS  followed 1047 non-diabetic subjects in relation to incident diabetes within 5 years. The 144 subjects who presented with diabetes at follow-up had higher baseline levels of PAI-1. PAI-1 predicted the development of diabetes independently of biological features of the metabolic syndrome, C-reactive protein and other known risk factors for diabetes. It has recently been shown that −675 4G/4G PAI-1 genotype is associated with an increased risk of obesity , with higher blood concentrations of glucose, insulin, triglyceride and lower HDL-cholesterol . This might suggest an increased insulin resistance in these carriers. Taken together, these results support an effect of PAI-1 on adiposity, insulin resistance and diabetes.
More investigations are required to unravel a possible contribution of PAI-1 to the development of the metabolic syndrome and to determine if PAI-1 could represent a potential target for therapeutic intervention aiming to decrease the risk of both cardiovascular disease and Type 2 diabetes.