Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:2588-2593
Published online before print October 5, 2006,
doi: 10.1161/01.ATV.0000248734.89782.37
(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:2588.)
© 2006 American Heart Association, Inc.
Novel Platelet and Vascular Roles for Immunoreceptor Signaling
Frederick F. Samaha;
Mark L. Kahn
From Department of Medicine and Division of Cardiology, University of Pennsylvania, Philadelphia, PA.
Correspondence to Mark Kahn, Department of Medicine and Division of Cardiology, University of Pennsylvania, 952 BRB II/III, 421 Curie Blvd, Philadelphia, PA 19104. E-mail markkahn{at}mail.med.upenn.edu; or Frederick Samaha, Division of Cardiology, Philadelphia Veterans Administration Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104. E-mail rick.samaha@va.gov
Series Editor: Lawrence Brass
Platelet Activation and the Formation of the Platelet Plug
ATVB In Focus
Previous Brief Reviews in this Series:
Tsai H-M. Deficiency of ADAMTS13 causes thrombotic thrombocytopenic purpura. 2003;23:388396.
Quinn MJ, Byzova TV, Qin J, Topol EJ, Plow EF. Integrin
IIbß3 and its antagonism. 2003;23:945952.
Newman PJ, Newman DK. Signal transduction pathways mediated by PECAM-1: new roles for an old molecule in platelet and vascular cell biology. 2003;23:953964.
Flaumenhaft. Molecular basis of platelet granule secretion. 2003;23:11521160.
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Abstract
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The immunoreceptor signaling pathway has classically been defined
by its role in mediating intracellular signals downstream of
immune receptors on circulating cells, but recent studies have
revealed new and unexpected roles for this pathway in vascular
biology. In platelets the immunoreceptor signaling pathway is
coupled to 2 structurally distinct platelet collagen receptors,
glycoprotein VI and integrin

2ß1, and is required
for the activation of platelets after exposure to vessel wall
collagen during plaque rupture. During vascular development
immunoreceptor signaling is required for proper formation of
the lymphatic system, a role that has revealed the contribution
of hematopoietic endothelial progenitors to that process. In
conjunction with the identification of new biological roles
in vascular cell types, new molecular mechanisms of activating
this signaling pathway have been discovered, including activation
by integrins and immunoreceptor tyrosine activation motifs (ITAMs)
on receptors that do not function as part of the immune response.
Here we discuss some of these recent findings and their implications
for vascular biology and the treatment of human vascular diseases.
Recent studies have revealed novel and diverse roles for immunoreceptor signaling in vascular biology. In the present review we discuss immunoreceptor signaling downstream of platelet collagen receptors and in hematopoietic cells that contribute to the developing lymphatic vascular system, as well as future clinical and scientific directions of this field.
Key Words: vascular biology immunoreceptor ITAM platelet
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Introduction
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Immune receptors are a family of multi-subunit receptors that
play critical roles in the adaptive immune response. Classical
immune receptors, such as the T cell receptor, B cell receptor,
and Fc receptors, are composed of specialized subunits that
participate in either ligand binding or intracellular signaling.
Activation of intracellular signaling by multi-subunit immune
receptors is triggered by tyrosine phosphorylation at a region
known as the immunoreceptor tyrosine activation motif, or ITAM,
on the signal transducing subunit.
1 Once phosphorylated, tyrosine
residues within the ITAM consensus sequence (YxxI/Lx
6 to 8YxxI/L)
bind the tandem SH2 domains of either Syk or ZAP-70, 2 related
nonreceptor tyrosine kinases, an interaction that leads to conformational
release and activation of the kinase. Most signals downstream
of immune receptors are mediated by these kinases, with ZAP-70
serving as the primary kinase in T cells and Syk as the primary
kinase in other hematopoietic cell types, including platelets.
Interestingly, immune receptors such as the T cell receptor
contain up to 10 distinct ITAMs, whereas homologous receptors
such as the platelet collagen receptor glycoprotein VI (GPVI)
signal through a single ITAM unit. Presumably the number and
structural context of these ITAMs provide a mechanism for modulation
of signaling.
2
The event that triggers signaling following the binding of immune receptors to ligand is ITAM phosphorylation by Src family tyrosine kinases, a large family of nonreceptor tyrosine kinases that transduce signals downstream of numerous cell surface receptors. While the molecular mechanism by which ligand binding drives ITAM phosphorylation is not well understood, clustering of receptors driven by binding to multivalent ligand appears necessary and may bring the ITAM-bearing subunits into contact with activated Src family kinases in specialized regions of the cell membrane known as lipid rafts.3 Lipid rafts are cholesterol-rich regions of the cell membrane that are biochemically defined by resistance to detergent and are enriched in many of the signaling molecules utilized by immune receptors, including the Src family kinases and the transmembrane lipid raft adaptor molecular LAT (linker in activated T cells). The intracellular domain of LAT contains multiple tyrosines that when phosphorylated bind the SH2 domains of critical signaling effectors, including the adaptors GADS and GRB2 and the phospholipase PLC
2.4 SLP-76 and its B cell homologue SLP-55 (also known as BLNK and BASH) are cytoplasmic adaptors that are also critical for immune receptor signaling. Recruitment of SLP-76 to the membrane by GADS-LAT interaction allows formation of the canonical immune receptor signaling complex. Essential roles for the major components of this signaling complex, including Syk, SLP-76, LAT, and PLC
2, in the generation of adaptive immune responses have been demonstrated genetically by the generation of knockout mice with immune defects.58 Significantly, many of the components of this canonical immune signaling pathway are expressed in nonimmune hematopoietic cells such as platelets and osteoclasts, where the pathway lies downstream of receptors that are structurally and functionally homologous to immune receptors but participate in nonimmune biological roles, such as collagen signaling by the platelet GPVI collagen receptor.
The presence of alternative, noncanonical means of activating the immune receptor signaling pathway have emerged primarily from studies of Syk, the intracellular kinase responsible for activating this pathway outside of T cells. A link to integrin signaling was established by the observation that adhesion of platelets to fibrinogen through the
IIbßIII integrin (also known as GPIIbIIIIa) results in Syk phosphorylation and Syk co-immunoprecipitates with the cytoplasmic tails of ß integrin subunits.9,10 Functionally, some integrin-mediated responses, such as the spreading of platelets on fibrinogen and the activation of neutrophils in response to integrin ligand, are deficient in cells that lack Syk, SLP-76, or PLC
2.1113 An important finding of such functional studies has been that the lipid raft adaptor LAT, critical for signaling downstream of immune-type receptors, is dispensable for integrin-mediated activation of this pathway.1416 Thus a noncanonical mechanism of activating the immune receptor signaling pathway through integrins exists and appears to operate outside of lipid rafts (Figure).
As a result of the dual role played by many of the key components of this pathway in canonical and noncanonical signals, it is not known whether the loss of any particular cellular function observed in mice lacking Syk, Slp-76, or PLC
2 is caused by loss of ITAM signaling, integrin signaling, or both. In the case of platelet responses to the extracellular matrix protein collagen, convergence of integrin and ITAM receptors at the level of intracellular signal transduction is accompanied by convergence at the level of extracellular ligand binding, as platelets express both an immune-type collagen receptor, GPVI, and a collagen-binding integrin,
2ß1. Whether and to what extent integrin and immune receptor type activation of this signaling pathway operates in platelets and in other cell types is not yet known. A clear definition of the biological roles of noncanonical signaling through the immune receptor pathway remains an important future area for investigation.
Finally, in addition to activation by immune receptor ITAMs and by integrins, recent studies have demonstrated Syk binding and activation by ITAM-like sequences in proteins that are not homologous to immune receptors.17 A recent bioinformatics analysis identified no fewer than 48 proteins that met stringent criteria for an ITAM motif and up to 368 that met less stringent criteria.18 The biological role of these alternative ITAM-containing proteins in the activation of Syk and this pathway remains to be defined, but these novel ITAMs may explain the expression and function of Syk in cells outside the hematopoietic system.19
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Immunoreceptor Signaling in Platelet Collagen Responses
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The possibility that the biological roles of canonical, ITAM-activated
immunoreceptor signaling and those of noncanonical, integrin-activated
immunoreceptor signaling may converge is highlighted by the
utilization of this pathway in platelet collagen responses.
Platelets are anuclear, small circulating cells in the blood
that are activated during vessel wall injury and are required
for hemostasis in the arterial system. In the absence of stimuli
that trigger intracellular signals, resting platelets circulate
in the blood in contact with both the endothelial lining of
the vessel wall and blood proteins such as fibrinogen, but bind
neither. In contrast, activated platelets participate in hemostasis
and thrombosis by binding the injured vessel wall and each other
(via dimeric fibrinogen molecules). A primary stimulus for platelet
activation after vessel injury is the matrix protein collagen
that is exposed after disruption of the vascular endothelium.
Unlike platelet activation by thrombin, ADP and thromboxane,
classic soluble activators of G protein-coupled signaling in
platelets, the molecular basis of the platelet collagen response
has only recently been understood. Syk and the ITAM-containing
immunoreceptor signaling adaptor Fc R

were noted to be required
for platelet collagen responses even before the platelet receptor
coupled to those signaling proteins was cloned.
20 Biochemical
studies revealed the collagen-binding subunit of this receptor
to be GPVI, an Ig-domain containing receptor whose predicted
amino acid sequence and genomic locus identify it as a homologue
of immune receptors such as the Fc receptor for IgA.
21 Genetic
studies in mice have confirmed that loss of GPVI, Slp-76, or
PLC

2 results in the loss of collagen activation of platelets,
confirming the requirement for ITAM-activated, canonical immunoreceptor
signaling for this platelet response.
5,22,23
A second collagen receptor expressed on the surface of platelets is the integrin
2ß1.24 Because
2ß1, like other platelet integrins, is held in an inactive conformation and unable to bind ligand until released by inside-out signals,25,26 it has remained unclear whether or not this collagen-binding integrin participates in the generation of collagen signals.27 The integrin
2ß1 is not required for wild-type platelet aggregation responses induced by fibrillar collagen,14,28 but is required when GPVI signaling is reduced either genetically or pharmacologically.14
2ß1 is also required for firm adhesion of platelets to immobilized fibrillar collagen under flow conditions that reproduce in vivo platelet-collagen interaction.29,30 These findings are consistent with either a secondary signaling role for
2ß1 after GPVI activation of the integrin or an adhesive role for
2ß1 that confers GPVI co-receptor function required for receptor activation by weak ligands or under flow conditions. These biological roles are not mutually exclusive. While at this time there are no definitive data that distinguish between these 2 possibilities, genetic studies in mice provide indirect support for direct
2ß1-mediated signals. LAT-deficient platelets exhibit a severe loss of response to GPVI-specific ligands such as the snake venom convulxin or collagen-related peptides,31 but retain responses to collagen.14,29,32 Moreover, LAT-deficient platelet collagen responses require integrin
2ß1. This requirement is not easily explained via GPVI co-receptor function because LAT-deficient platelets express normal levels of surface GPVI. Instead these studies may reflect the ability of integrins to activate the immunoreceptor signaling pathway in a lipid raft-independent, LAT-independent manner. Precise definition of whether and how integrins activate immunoreceptor signaling independently of ITAMs remains a significant open question for future investigation.
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Immunoreceptor Signaling in Vascular Development: Revealing a Link Between Hematopoietic Cells and New Vessel Formation
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An unsuspected link between immunoreceptor signaling and the
vascular system emerged with the first report of mice lacking
the Syk kinase.
6,33 Syk-deficient mice appeared "hemorrhagic"
and edematous in mid-gestation and died postnatally in association
with the development of chylous ascites. Similar phenotypes
were observed in mice lacking SLP-76
23 and PLC

2.
5 Further phenotypic
evaluation of these animals revealed a surprising finding: the
vascular abnormalities were the result of defects that arose
during formation of the lymphatic vascular system and culminated
in vascular connections between nascent lymphatics and pre-existing
blood vessels.
34 Mice lacking Syk, SLP-76, or PLC

2 develop lymphatics
at the same time and in the same manner as wild-type mice, but
in a limited number of new lymphatic vessels connections are
made to blood vessels, filling the developing lymphatic system
with blood. Histologically the lymphatic vessels of mice lacking
this pathway appear structurally normal but molecular analysis
reveals the presence of endothelial cells carrying lymphatic
molecular markers fused to blood endothelial cells lacking those
markers.
34 Examination of Syk, Slp-76, and PLC

2 mRNA expression
in developing embryos has confirmed expression in circulating
blood cells but failed to reveal expression in either blood
or lymphatic endothelial cells. These studies have established
a new role for the immune receptor signaling pathway in vascular
development, but the question of how the signaling pathway regulates
vascular development was not understood until recently.
Studies designed to investigate this question have yielded unexpected insights into the relationship between blood and endothelial cells during vascular development. Consistent with the lack of detectable expression in embryonic endothelial cells, we have used a GATA1-GFPSlp-76 transgene that drives expression in blood but not endothelial cells to rescue the vascular phenotype of Slp-76deficient mice (Mark L. Kahn, unpublished observations). The GATA1-GFPSlp-76 transgene drives expression of a GFPSlp-76 fusion protein in a limited number of circulating cell types but not in endothelial cells, indicating that the endothelial requirement for immunoreceptor signaling is either indirect, ie, required in circulating cells to direct endothelial cell function, or is in endothelial cells that originate from hematopoietic cells. To distinguish between these possibilities we analyzed chimeric embryos in which deficient cells and wild-type cells were mixed to test cell autonomy. In this experiment, deficient cells conferred the vascular phenotype despite the presence of wild-type circulating cells, a result consistent with a cell autonomous defect in hematopoietic endothelial progenitors. Consistent with this mechanism, surviving Slp-76deficient adult mice lack circulating endothelial precursors that express lymphatic molecular markers, a cell type that could link the hematopoietic cells to the lymphatic vascular system.
A common origin has been established for blood and endothelial cells early in embryonic development, on the basis of close spatial and temporal association,35 genetic studies,36,37 and studies of cultured embryonic stem cells.38 Recent studies using adult animals have extended this relationship with evidence that mature hematopoietic stem cells can give rise to circulating cells that participate in adult vessel growth in response to angiogenic stimuli.39 Whether such cells contribute to normal vascular development after the establishment of the hematopoietic system has not been known, however, and the vascular defects in mice lacking immunoreceptor signaling provide new genetic evidence for such a role. How this signaling pathway is utilized in hematopoietic endothelial progenitor cells is not yet known, but further studies to fate-map hematopoietic cells that express Syk and Slp-76 during lymphatic vascular development and functional studies of circulating endothelial progenitor cells lacking this pathway should yield new insights into the how blood cells participate in vessel formation both during and after embryonic development.
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Immunoreceptor Signaling in Vascular Biology: Clinical Implications
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The recently identified roles of immunoreceptor signaling in
platelets and in circulating endothelial progenitors (CEPs)
suggest potential roles in the pathogenesis and treatment of
human vascular diseases. In the case of platelet collagen receptors,
a clear path exists between the molecular understanding of how
these cells respond to vessel wall injury and the development
of novel agents to block that response during the first stages
of myocardial infarction or stroke. In the case of immunoreceptor
signaling in CEPs, it is possible that this pathway can be used
to alter the number and/or identity of such endothelial precursors
to drive or inhibit vascular growth, eg, in the setting of ischemia
or tumor angiogenesis. While clinical application of immunoreceptor
signaling in progenitor/precursor cells remains entirely speculative
at this time, more concrete clinical data exist in support of
targeting platelet collagen receptors to treat human vascular
diseases.
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Platelet Collagen Receptors as Potential Risk Factors and Therapeutic Targets
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Platelet collagen responses are believed to be a primary response
of unactivated, circulating platelets to vessel wall injury,
and platelet-activating signals generated by platelet collagen
receptors may therefore play a determinative role in the thrombotic
outcome of plaque rupture in the coronary and cerebral vasculature.
Studies of human GPVI deficiency states and blockade of integrin

2ß1
14,40 confirm that GPVI and

2ß1 play
similar roles in human and mouse platelets.
41,42 This model
has led to the hypothesis that an individuals platelet
collagen receptor activity may function as an independent risk
factor for stroke and myocardial infarction and, conversely,
that inhibition of that activity could provide protection against
thrombus formation after plaque rupture. A straightforward mechanism
by which individual platelet collagen responses may vary is
receptor density. An early study of GPVI-mediated collagen signaling
in a cell line revealed that GPVI affinity for collagen is relatively
weak and that collagen responses were highly dependent on receptor
density.
43 Earlier studies of

2ß1 polymorphisms in
human subjects found polymorphisms associated with higher platelet
receptor densities are also associated with an increased risk
of myocardial infarction (MI) and stroke.
4449 In unactivated
circulating platelets the integrin

2ß1, like the

IIbßIII
integrin, is held in an off state and unable to bind collagen.
25,26 Thus in the primary activation of platelets after plaque rupture
and collagen exposure it appears that the GPVI receptor may
play the largest role.
Several previous studies of healthy human subjects have demonstrated that platelet GPVI and
2ß1 density are tightly regulated in healthy human volunteers, with only
1.5- to 5.0-fold variation in both GPVI and a2b1 density.5052 These studies also found only modest correlation between GPVI and
2ß1 densities (r=0.35 to 0.46). We recently performed a study addressing the question of platelet collagen receptor density in 209 human subjects with a high prevalence of myocardial infarction. Through the use of a novel anti-glycoprotein VI (GPVI) monoclonal antibody and a previously characterized anti-integrin
2ß1 antibody to directly measure the density of platelet collagen receptors by flow cytometry, we found a 16-fold variation in expression of GPVI and a 23-fold variation in expression of
2ß1, with a strong correlation between GPVI and
2ß1 density (r=0.68 P<0.0001). Thus, these findings differed significantly from those of previous studies in healthy human subjects. Interestingly, however, our findings are similar to another recent study of 367 patients with ischemic heart disease, which found a 16-fold variation in
2ß1 levels and a 7-fold variation in GPVI levels, with a highly significant correlation between the 2 (r=0.702; P=0.001).53 In fact, this study showed a possible upregulation of both receptors in patients with an acute coronary syndrome. Thus, the degree of regulation of platelet collagen density between individuals, and in response to clinical status requires further study.
Studies of GPVI polymorphisms have been less clear. One study identified a GPVI coding region polymorphism (T683C) that correlates with lower GPVI receptor density and diminished platelet aggregation in response to collagen,51 suggesting that platelet GPVI polymorphisms associated with lower receptor densities confer less robust platelet responses,51 but a separate study of the same polymorphism found it associated with an increased risk of myocardial infarction.54 Thus whether and how GPVI polymorphisms can be used to predict receptor density and risk of atherothrombosis is unclear. To address this question we have recently performed a, case-control study, comparing 77 patients with prior myocardial infarction to 77 control patients, matched on the basis of traditional risk factors for myocardial infarction.55 In this study, we did not find a strong association between heterogeneity at the GPVI 683C allele and GPVI receptor density, as measured using a monoclonal antibody and flow cytometry.55 However, a GPVI or
2ß1 density within the lowest decile was associated with a significantly lower likelihood of prior myocardial infarction (odds ratio, 6.3; 95% confidence interval, 1.3 to 29.2; P=0.009). Thus while preliminary studies of human platelet collagen receptor density suggest a direct relationship to the risk of stroke and myocardial infarction, larger studies are necessary to confirm and quantitate this risk and to determine if any particular polymorphisms can be used to predict receptor density.
In addition to predicting clinical risk, the inhibition of platelet collagen responses would appear to hold significant therapeutic promise. Present anti-platelet therapies have proven efficacy for treatment of both myocardial infarction and thrombotic complications secondary to percutaneous coronary intervention. Use of these agents is limited, however, by the fact that available agents either act as blanket inhibitors of platelet aggregation (eg, the IIb/IIIa inhibitors) or function in a nonspecific manner to reduce autocrine platelet signaling (eg, aspirin and ADP antagonists such as clopidogrel). Powerful IIb/IIIa inhibitors are difficult to use chronically because effective doses can result in unacceptable bleeding risk, while inhibitors of autocrine signaling through thromboxane generation or ADP are amenable to chronic use but are not powerful enough to antagonize strong thrombotic stimuli independently.56 An ideal anti-platelet therapy would target the causal event in atherothrombotic disease states but not incapacitate the platelet response to the point at which serious bleeding would prevent long term therapy. Targeting the initial event in platelet activation at sites of arterial vascular injury through the platelet collagen receptor GPVI might provide such a strategy. Loss of GPVI function results in reduced arterial thrombosis in mice,5759 although the extent of GPVIs role in arterial thrombosis assays is dependent on the nature and extent of vessel injury and may be strongly influenced by the generation of thrombin, a potent activator of platelets.59,60 GPVI deficiency in humans results in only a mild bleeding disorder,61 suggesting that anti-GPVI agents could reduce arterial thrombosis associated with myocardial infarction or stroke with a tolerable long-term bleeding risk. The fact that GPVI receptors on platelets are cleared in vivo for >2 weeks after a single injection of anti-GPVI antibodies in mice,57 the recent development of anti-GPVI antibodies capable of blocking collagen activation of GPVI14 as well as the recently solved crystal structure of the GPVI ectodomain62 suggest that multiple strategies could be used to develop novel anti-GPVI agents for clinical use.
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Conclusions
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Recent basic science and clinical studies have revealed diverse
and unexpected vascular roles for an intracellular signaling
pathway previously associated exclusively with immune responses.
While based in the hematopoietic system, these roles include
the regulation of hemostasis and thrombosis via collagen and
integrin signals in platelets as well as the regulation of vascular
development by circulating endothelial precursor cells. Remarkably,
the biological diversity of this signaling pathway in the vascular
system is matched by its molecular diversity; it can be activated
by multi-subunit receptors that structurally resemble immune
receptors, by integrins and perhaps by other classes of receptors
that couple to novel ITAM-containing proteins as well. While
the studies performed to date suggest broad and important vascular
roles for this signaling pathway, the cellular and molecular
basis for these roles remain mostly unknown and promise to be
an exciting area of vascular biology in the future.
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Acknowledgments
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Disclosures
None.
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Footnotes
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Consulting Editor for this article was Steven R. Lentz, MD,
PhD, Department of Internal Medicine, University of Iowa.
Original received July 6, 2006; final version accepted September 15, 2006.
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