The best characterized function of Protein S is its role in the anti
coagulation pathway, where it functions as a cofactor to
Protein C in the inactivation of
Factors Va and
VIIIa. Only the free form has cofactor activity. Protein S binds to negatively charged
phospholipids via the carboxylated Gla domain. This property allows Protein S to facilitate the removal of cells that are undergoing
apoptosis, a form of structured cell death used by the body to remove unwanted or damaged cells. In healthy cells, an ATP (
adenosine triphosphate)-dependent enzyme removes negatively charged phospholipids such as phosphatidyl serine from the outer leaflet of the cell membrane. An apoptotic cell (that is, one undergoing
apoptosis) no longer actively manages the distribution of phospholipids in its outer membrane and hence begins to display negatively charged phospholipids on its exterior surface. These negatively charged phospholipids are recognized by
phagocytes such as
macrophages. Protein S binds to the negatively charged phospholipids and functions as a bridge between the apoptotic cell and the phagocyte. This bridging expedites phagocytosis and allows the cell to be removed without giving rise to
inflammation or other signs of tissue damage. Protein S does not bind to the nascent complement complex C5,6,7 to prevent it from inserting into a membrane. This is a different complement protein S AKA
vitronectin made by the VTN gene, not to be confused with the coagulation protein S made by the PROS gene which this wiki page concerns. ==Pathology==