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Platelet interaction with the subendothelium is essential to limit blood loss after tissue injury. However, upon rupture of atherosclerotic plaques, this interaction may result in blood vessel occlusion leading to life threatening diseases such as myocardial infarction or stroke. Among the subendothelial matrix proteins, collagen is considered to be the most thrombogenic component as it directly activates platelets. Platelets interact with collagen, either indirectly through glycoprotein (GP) Ib-V-IX receptor complex, or directly through the major collagen receptor on the platelet surface, GPVI. The work presented here focused on studying the cellular regulation of GPVI. In addition, a possible role for GPVI in thrombus formation induced by atherosclerotic plaque material was investigated and it was found that GPVI plays an important role in this process. Using a recently published mitochondrial injury model, it was found that GPVI contains a cleavage site for a platelet-expressed metalloproteinase. Further studies showed that platelet activation by CRP, or thrombin induced down-regulation of GPIb, but not GPVI. In parallel, cellular regulation of GPV was studied and it was found that GPV is cleaved in vitro by the metalloproteinase ADAM17. In previous studies it was shown that injection of mice with the anti-GPVI mAb, JAQ1, induces GPVI down-regulation, which is associated with a strong, but transient, thrombocytopenia. Using new anti-GPVI mAbs, which bind different epitopes on the receptor, it is shown in this study that GPVI down-regulation occurs in an epitope-independent manner. Further experiments showed that antibody treatment induces a transient, but significant increase in bleeding time. Using different genetically modified mice, it is shown that, upon antibody injection, GPVI is both, shed from the platelet surface and internalized into the platelet. Signaling through the immunoreceptor tyrosine-based activation motif (ITAM) of the FcR chain is essential for both processes, while LAT and PLC2 are essential for the shedding process only. Antibody-induced increase in bleeding time and thrombocytopenia were absent in LAT deficient mice, showing that it is possible to uncouple the associated side effects from the down-regulation process. As antibody-induced GPVI internalization still occurs in LAT and PLC2 deficient mice, this suggests a novel signaling pathway downstream of GPVI that has not been described so far.
Platelet activation and adhesion results in thrombus formation that is essential for normal hemostasis, but can also cause irreversible vessel occlusion leading to myocardial infarction or stroke. The C-type lectin-like receptor 2 (CLEC-2) was recently identified to be expressed on the platelet surface, however, a role for this receptor in hemostasis and thrombosis had not been demonstrated. In the current study, the involvement of CLEC-2 in platelet function and thrombus formation was investigated using mice as a model system. In the first part of the thesis, it was found that treatment of mice with a newly generated monoclonal antibody against murine CLEC-2 (INU1) led to the complete and highly specific loss of the receptor in circulating platelets (a process termed “immunodepletion”). CLEC-2-deficient platelets were completely unresponsive to the CLEC-2-specific agonist rhodocytin, whereas activation induced by all other tested agonists was unaltered. This selective defect translated into severely decreased platelet aggregate formation under flow ex vivo; and in vivo thrombosis models revealed impaired stabilization of formed thrombi with enhanced embolization. Consequently, CLEC-2 deficiency profoundly protected mice from occlusive arterial thrombus formation. Furthermore, variable bleeding times in INU1-treated mice indicated a moderate hemostatic defect. This reveals for the first time that CLEC-2 significantly contributes to thrombus stability in vitro and in vivo and plays a crucial role in hemostasis and arterial thrombosis. Thus, CLEC-2 represents a potential novel anti-thrombotic target that can be functionally inactivated in vivo. This in vivo down-regulation of platelet surface receptors might be a promising approach for future anti-thrombotic therapy. The second part of the work investigated the effect of double-immunodepletion of the immunoreceptor tyrosine-based activation motif (ITAM)- and hemITAM-coupled receptors, platelet glycoprotein (GP) VI and CLEC-2, on hemostasis and thrombosis using a combination of the GPVI- and CLEC-2-specific antibodies, JAQ1 and INU1, respectively. Isolated targeting of either GPVI or CLEC-2 in vivo did not affect expression or function of the respective other receptor. However, simultaneous treatment with both antibodies resulted in the sustained loss of GPVI and CLEC-2 signaling in platelets, while leaving other activation pathways intact. In contrast to single deficiency of either receptor, GPVI/CLEC-2 double-deficient mice displayed a dramatic hemostatic defect. Furthermore, this treatment resulted in profound impairment of arterial thrombus formation that far exceeded the effects seen in single-depleted animals. Importantly, similar results were obtained in Gp6-/- mice that were depleted of CLEC-2 by INU1-treatment, demonstrating that this severe bleeding phenotype was not caused by secondary effects of combined antibody treatment. These data suggest that GPVI and CLEC-2 can be independently or simultaneously down-regulated in platelets in vivo and reveal an unexpected functional redundancy of the two receptors in hemostasis and thrombosis. Since GPVI and CLEC-2 have intensively been discussed as potential anti-thrombotic targets, these results may have important implications for the development of novel, yet save anti-GPVI or anti-CLEC-2-based therapies.